The Evolving Spectrum of Ejection Fraction
Volume 7, Issue 3
This week marked a personal milestone for me, as it was the first time since 2019 that I was able to attend a live, in-person professional meeting. The Heart Failure Society of America (HFSA) held their annual meeting in Denver, and I was one of the many who flocked back towards networking opportunities, symposia, posters, and industry exhibitions.
The meeting organizers required proof of vaccination to attend, masks were required at all times, and color-coded lanyards were used to signal others as to your social distancing preferences. Overall, the meeting was great, and I picked up on several pieces of interesting clinical insight.
In the past, Talking Therapeutics (TT) has covered virtual meetings, but in this week’s installment, we have our first live meeting report out!
Point 1: SGLT2 Inhibitors and HFpEF Dominated the Meeting
Rightfully so. Prior TT columns have covered the EMPEROR-Preserved trial, which was just published last month. At the HFSA meeting, additional data and insights were presented that further outlined the salutary effects of these agents in the heart failure with preserved ejection fraction (HFpEF) population.
In this analysis of dapagliflozin (Farxiga) therapy, the PRESERVED-HF trial showed that Kansas City Cardiomyopathy Questionnaire (KCCQ) clinical summary scores were 5.8 points higher for patients randomized to the SGLT2 inhibitor over placebo (P=.001)—bringing scores from the low 60s at baseline to the high 60s. Dapagliflozin helped with symptoms and physical limitations of all HFpEF subgroups regardless of diabetes status or left ventricular ejection fraction (LVEF), with a number needed to treat of just 9 for a patient to have a clinically meaningful improvement in health status at 12 weeks.
Patients also entered the trial with a baseline median 6-minute walking distance of just 244 meters, and the dapagliflozin group was able to increase their results by 20.1 meters over placebo after 12 weeks of therapy (P=.007).
Point 2: When pEF May Not Really Be pEF
A significant number of symposia focused on the tapering of benefit for both SGLT2 inhibitors and angiotensin receptor-neprilysin inhibitor (ARNI) therapy in patients with EFs greater than 60%. The expert faculty pointed out that both of these groups in the EMPEROR-Preserved and PARAGON trials were older, with higher Afib burdens and low levels of brain natriuretic peptide. This led the experts to posit that this phenotype of patient may in fact not have true HFpEF, but their heart failure symptoms may be due to their underlying comorbidities.
While no firm conclusions can be drawn, it was clear that not all HFpEF patients are the same and that those with EF values greater than 65% need to be studied separately from those with EF 50-65%, as the latter group appears to derive benefit from currently available therapies like SGLT2 inhibitors and ARNI therapy.
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